Organization
92 REASONS
Active
Parent organization
SODA CANNON LLC.
Other names
92 Reasons
Organization subpart
Yes
Provider details
NPI number
Legal business name
SODA CANNON LLC.
Authorized official
SOPHIA CANNON MCRC, CRC, LPC (DIRECTR OF CLINICAL SERVICES)
(469) 986-9629
Entity
Organization
Contact information
Practice address
1332 TEASLEY LN STE 103A, DENTON, TX 76205-7946
(469) 986-9629
Mailing address
1005 LAKE HOLLOW DR, LITTLE ELM, TX 75068-8411
(469) 986-9629
(469) 453-3193
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
07/30/2020
Last updated
07/30/2020
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